Detecting silent coronary stenoses and stratifying cardiac risk in patients with diabetes: ECG stress test or exercise myocardial scintigraphy?

Diabet Med. 2004 Apr;21(4):342-8. doi: 10.1111/j.1464-5491.2004.01157.x.


Aims: To determine whether performing a myocardial scintigraphy immediately after a maximal electrocardiogram (ECG) stress test is effective in detecting silent coronary stenoses and predicting cardiovascular events.

Methods: Asymptomatic patients (n = 262) aged 57.6 +/- 8.8 years, with diabetes for 12.0 years (5-39) [median (range)] and no history of a cardiac event, underwent a maximal ECG stress test followed by a myocardial scintigraphy. The patients with an abnormal ECG stress test or abnormal imaging underwent a coronary angiography. Cardiac events were assessed in 250 (95.4%) patients followed for 37.8 months (3-101).

Results: The ECG stress test was abnormal in 54 patients. Among them, 18 had coronary stenoses and seven had a cardiac event. Despite a normal ECG stress test, the myocardial scintigraphy was abnormal in 42 additional patients, including 16 patients with coronary stenoses. Four of these 42 patients experienced a cardiac event. Follow-up showed a poor prognosis in subjects who were abnormal on the two tests. Univariate predictors of the 15 cardiac events were the ECG stress test [odds ratio (OR) 3.9, 95% confidence interval (CI) 1.3, 11.4, P = 0.008], myocardial scintigraphy (OR 3.8, 95% CI 1.3, 11.0, P = 0.009), coronary stenoses (OR 26.6, 95% CI 7.6, 90.7, P < 0.001), and peripheral or carotid occlusive arterial disease (OR 9.5, 95% CI 2.1, 42.5, P < 0.001).

Conclusions: In the asymptomatic patients with diabetes, combining a myocardial scintigraphy with a maximal ECG stress test is effective in detecting more patients with coronary stenoses and predicting cardiovascular events. However, the ECG stress test has a good negative predictive value for cardiac events (97%), is cheaper, and should therefore be proposed first.

MeSH terms

  • Cardiovascular Diseases / diagnosis
  • Cohort Studies
  • Coronary Angiography
  • Coronary Stenosis / diagnosis*
  • Coronary Stenosis / diagnostic imaging
  • Diabetic Angiopathies / diagnosis*
  • Diabetic Angiopathies / diagnostic imaging
  • Electrocardiography
  • Exercise Test
  • Female
  • Heart / diagnostic imaging*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnosis
  • Myocardial Ischemia / diagnostic imaging
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Radionuclide Imaging
  • Risk Factors